In July 1997, the State of New Mexico established a Medicaid managed care (MMC) Program for physical and mental health services. This program led to adverse effects in the state's mental health safety net, as 69 community-based programs closed. In October 2000, the Health Care Financing Administration (HCFA) announced that it would not renew the waiver that allowed the state to provide mental health services under MMC. It later rescinded this decision. However, HCFA has required the creation of an advisory committee comprised of Medicaid recipients and providers, which is to participate in the redesign of mental health services under MMC. This comparative, multi-site ethnographic project will investigate the effects of the current integrated program and future Medicaid reform on the provision of mental health services in New Mexico, a state with a predominately rural and ethnically diverse population. Two specific aims have been developed for this proposed project: (1) To assess the effects of Medicaid reform on mental health safety net institutions and on two demographically and culturally distinct rural communities. Such institutions include psychiatric hospitals, residential treatment centers, day treatment and partial hospitalization programs, outpatient treatment settings, and primary care provider offices. (2) To assess the effects of Medicaid reform on access barriers and the availability and perceived quality of culturally sensitive mental health care to the Anglo, Hispanic, and Native American populations that reside in these communities A combination of qualitative data collection techniques, including participant observation and in-depth, semi-structured interviewing, will be used to examine the changing social and organizational contexts of the state's Medicaid mental health services delivery system. The results of this project will clarify the differential influence of Medicaid managed care on accessibility, utilization, and quality of mental health care for Medicaid recipients in historically underserved, multiethnic regions of New Mexico. This project also will serve to establish a baseline against which to analyze future Medicaid reform and to demonstrate how macro-level health policy impacts safety net institutions that provide mental health services to rural and frontier populations.